Osteotomies in Patello-Femoral Instabilities

Background: Patellar instability (PFI) is a common condition characterized by recurrent dislocations or subluxations of the patella, often leading to significant pain and functional impairment. Contributing factors in PFI include anatomical abnormalities such as lateralization of the tibial tubercle and alta patella, which can increase lateral forces on the patella during knee movement. Osteotomy, particularly tibial tubercle osteotomy (TTO), has emerged as an effective surgical intervention for realigning the patellar tendon and restoring stability in patients with PFI. Consequently, understanding the indications for these procedures and their technical aspects is essential for optimizing surgical outcomes. Methods: This study focuses on the indications, techniques, and outcomes associated with tibial tubercle osteotomy, reviewing the current literature on osteotomies in the management of patellar instability. It synthesizes findings from various studies conducted between ۲۰۱۰ and ۲۰۲۲ that describe patient selection criteria based on anatomical evaluations, including imaging studies to assess the position of the tibial tubercle. This review also discusses different surgical approaches, such as direct medialization and anteromedialization of the tibial tubercle, along with their respective advantages and complications. Clinical outcomes from multiple studies are analyzed to provide a comprehensive understanding of the effectiveness of TTO in treating PFI. Results: Findings indicate that tibial tubercle osteotomy is indicated for patients with significant patellar instability due to malalignment or anatomical abnormalities. This procedure involves altering the position of the tibial tubercle to reduce lateral pull on the patella, which can significantly improve stability and decrease pain. Studies show that TTO can lead to successful outcomes in approximately ۷۰ to ۹۰ percent of cases, with substantial improvements in patient-reported outcomes and a reduction in recurrence rates of dislocation. Potential complications may include delayed healing, overcorrection, or persistent instability; however, these risks can be mitigated through careful preoperative planning and precise surgical techniques. Overall, TTO has proven effective in restoring proper alignment of the patellar tendon and improving knee function. Conclusion: In conclusion, osteotomy, particularly tibial tubercle osteotomy, is a vital surgical option for managing patellar instability associated with anatomical abnormalities. By precisely repositioning the tibial tubercle, surgeons can diminish excessive lateral forces on the patella, thereby reducing instability and pain for affected patients. Continued research is necessary to refine surgical techniques and establish standardized protocols for patient selection to maximize outcomes, as our understanding of patellofemoral mechanics evolves, so too must our strategies in addressing these complex conditions.

کلیدواژه ها:

Patellofemoral instability (PFI) ، Tibial tubercle osteotomy (TTO) ، Patellar alignment ، Surgical techniques ، Anteromedialization